A silence that speaks volumes

A review of Harry Stack Sullivan: Interpersonal Theory and Psychotherapy by F. Barton Evans, III (2024, Routledge; Second Edition)

The silence that settled around Harry Stack Sullivan after his death has been quite loud. It was as if posthumously some edict from on high in the medical community, or in the universe at large, commanded that he never be spoken of again after his ashes had been deposited with a military funeral at Arlington National Cemetery.

Sullivan contributed so much to new psychiatric thinking that he forced a new direction almost single-handedly. And the new direction was this: the author and creator of psychoanalysis, Sigmund Freud, was and remains indisputably the monumental figure in psychiatric history. No one in right mind would deny that. But Sullivan, after studying Freud and using his approach in therapy, forged alternate path, a path not dismissive of Freud but one that provided therapists with more than one option. Instead of the clinically detached observational posture of Freud, Sullivan chose the path of therapeutic interpersonal involvement with the patient, at least within the confines of the time and space of the office. He sent away the couch and set up two chairs at a 45 degree angle, allowing a face-to-face view but also making it easy to look away and avoid staring at the patient, and without making an issue of it. In other words Sullivan understood his style of psychotherapy as a process of building a personal relationship with the patient. That was a radical variation on Freud. And a review of the wider literature strongly suggests that most American psychiatry today follows Sullivan, even though he is not read, not discussed, and almost no one knows much about who he was.

The big difference between the two was that Freud personally was a simple neurotic and Sullivan was, like Anton Boisen, an episodic schizophrenic. But unlike Boisen, Sullivan kept his flaw hidden during his life. Thus Freud and Sullivan took quite different perspectives in their work, shaped largely by their own life experience. Each made an immense contribution to healing the broken, but in different ways.

Sullivan either anticipated the new direction of psychiatry after him, or he was the creator of it. I believe it was the latter, that Sullivan himself was the psychiatric game changer in the early twentieth century. And so it seems does F. Barton Evans, a person with considerably more creds than I have. Sullivan radically altered psychotherapy, but not in ways that diminished Freud by any means. Sullivan uncovered alternate healing paths, especially for schizophrenic patients, but also for neurotics. And Sullivan thereby reshaped the larger psychotherapeutic enterprise for both professionals and lay persons, such as clergy.

Looking back on my professional life, I am amazed - actually stunned - that I could work the field of pastoral psychotherapy for many decades and never hear or read the name Sullivan except in passing or on the cover of the cover of a book. The professional resentment toward him from his own profession has been, as I look back, palpable and destructive.

All the more amazing as I look back is the fact that Anton Boisen and Sullivan were close colleagues for twenty-five years, beginning even prior to Boisen’s first clinical training group, and ending only with Sullivan’s death in 1949. Sullivan was arguably more important to Boisen than even Freud.
Some authorities even contend that Boisen was Sullivan’s crypto-therapist, as strange as that may sound. How could I have been totally unaware of their relationship for so long? It appears that the pastoral community, except for Boisen, like the psychiatric community as a whole, had no interest in Sullivan during his lifetime or during the seventy-five years since his death. There is something wrong with this picture.

Blessedly there are a handful of authorities in the field who assess Sullivan as the monumental game-changer in the psychotherapeutic world of his day. And his influence is still relevant today. Most - probably all - of Sullivan’s comrades, like David Rioch, have now gone to their reward. But a very few in the subsequent generations, are realizing through research, that Sullivan was a monumental figure in psychotherapy. F. Barton Evans is currently, as seen from my perch, Sullivan’s principal adept to the world of psychotherapy, whether lay or professional, and is now attempting to set the record straight.

Evans’ assessment of Sullivan is especially relevant to religious leaders of any sort. They themselves are not going to make use of the Freudian couch, useful as that may still be for some psychiatrists. But religious leaders may well follow Sullivan’s healing approach through of “relating interpersonally” as the instrument of healing. And Sullivan was exceedingly successful with diagnosed schizophrenics, achieving an 80% cure rate. Freud had assessed schizophrenia as untreatable, which it was, using the couch approach. Sullivan’s interpersonal approach meant that he would sometimes even speak for the patient when the patient was mute, and until the patient could speak for himself. That is what I would call an authentically pastoral approach.

Sullivan himself is difficult reading, and most of his work is difficult to access. There is today a no better, readily available published source for grasping Sullivan than the volume published this year by F. Barton Evans.